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Observational Study
. 2014 Mar 4;3(2):e000486.
doi: 10.1161/JAHA.113.000486.

Delay from first medical contact to primary PCI and all-cause mortality: a nationwide study of patients with ST-elevation myocardial infarction

Sasha Koul  1 , Pontus Andell, Andreas Martinsson, J Gustav Smith, Jesper van der Pals, Fredrik Scherstén, Tomas Jernberg, Bo Lagerqvist, David Erlinge
Affiliations
Observational Study

Delay from first medical contact to primary PCI and all-cause mortality: a nationwide study of patients with ST-elevation myocardial infarction

Sasha Koul et al. J Am Heart Assoc. .

Abstract

Background: Early reperfusion in the setting of an ST-elevation myocardial infarction (STEMI) is of utmost importance. However, the effects of early versus late reperfusion in this patient group undergoing primary percutaneous coronary intervention (PCI) have so far been inconsistent in previous studies. The purpose of this study was to evaluate in a nationwide cohort the effects of delay from first medical contact to PCI (first medical contact [FMC]-to-PCI) and secondarily delay from symptom-to-PCI on clinical outcomes.

Methods and results: Using the national Swedish Coronary Angiography and Angioplasty Register (SCAAR) registry, STEMI patients undergoing primary PCI between the years 2003 and 2008 were screened for. A total of 13 790 patients were included in the FMC-to-PCI analysis and 11 489 patients were included in the symptom-to-PCI analyses. Unadjusted as well as multivariable analyses showed an overall significant association between increasing FMC-to-PCI delay and 1-year mortality. A statistically significant increase in mortality was noted at FMC-to-PCI delays exceeding 1 hour in an incremental fashion. FMC-to-PCI delays in excess of 1 hour were also significantly associated with an increase in severe left ventricular dysfunction at discharge. An overall significant association between increasing symptom-to-PCI delays and 1-year mortality was noted. However, when stratified into time delay cohorts, no symptom-to-PCI delay except for the highest time delay showed a statistically significant association with increased mortality.

Conclusions: Delays in FMC-to-PCI were strongly associated with increased mortality already at delays of more than 1 hour, possibly through an increase in severe heart failure. A goal of FMC-to-PCI of less than 1 hour might save patient lives.

Keywords: ST‐segment elevation myocardial infarction; percutaneous coronary intervention.

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Figures

Figure 1.
Figure 1.
Mortality across intervals of FMC‐to‐PCI delays in the overall patient cohort (Kaplan‐Meier). FMC indicates first medical contact; PCI, percutaneous coronary intervention.
Figure 2.
Figure 2.
Association between FMC‐to‐PCI delay and severe heart failure at discharge (error bars denote mean with standard error of the mean). FMC indicates first medical contact; PCI, percutaneous coronary intervention.
Figure 3.
Figure 3.
Mortality across intervals of symptom‐to‐PCI delays in the overall patient cohort (Kaplan–Meier). PCI indicates percutaneous coronary intervention.
See this image and copyright information in PMC

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